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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 09/04/2024
Date Signed: 09/05/2024 02:27:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/08/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20230508154924
FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:TILLMAN PINKFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 42DATE:
09/04/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:David AguinigaTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Questionable Death.
Staff is abusing residents in care.
Staff hide residents’ prohibited health conditions.
Staff steal residents’ money.
Staff steal resident belongings.
Staff threaten residents in care.
Staff are unlawfully evicting residents.
INVESTIGATION FINDINGS:
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This amended report supersedes the report issued on 05/23/2024. Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver the findings for the allegations listed above. LPA Urena met with Executive Director, David Aguiniga and explained the reason for the visit.
On 05/09/2023, Licensing Program Analyst (LPA) Angel Ascencio conducted an initial 10-day complaint. LPA Ascencio met with Interim Administrator Rafael Silva at 10:08 a.m. Entrance interview conducted. During the visit, LPA Ascencio reviewed staff files at 11:00 a.m. and obtained pertinent documents. LPA Ascencio advised Interim Administrator Silva that the allegation of Personal Rights has been referred to the Department's Investigation Branch (IB) for further review. Although IB did not conduct any additional investigation.
On 04/09/2024, LPA Urena requested additional documents pertinent to the investigation at 11:30 a.m. and interviewed the ED at 11:55 a.m.
Continues on LIC 9099C ...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 29-AS-20230508154924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 09/04/2024
NARRATIVE
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Pg. 2
On 05/23/2024, LPA Urena conducted a subsequent inspection and met Executive Director (ED) Marylou V. Mendoza and Assistant Administrator (AA) Virginia Sumulong. Staff and resident interviews were conducted and it was determined that further investigation was needed. On 06/19/2024, LPA Urena conducted an additional inspection and interviewed staff and the administrator between 12:45 p.m. to 3:30 p.m. LPA Urena also conducted two telephone interviews with staff on 06/19/2024.

Questionable Death

On the allegation of questionable death, it is the concern of the reporting party that residents die because staff make medication errors. No additional information was provided about the residents’ questionable death identifiers or the names of the medications. No contact information was provided for the reporting party to obtain additional information about the allegation. To investigate the allegation, the LPA reviewed the Department’s database for Deaths Reports (LIC624 A) for dates from January 2023 through June 2023. The LIC 624A reports received in our office indicate the manner of deaths to be of natural causes due to conditions contributing to death. Three (3) out of the four (4) deaths occurred at the hospital and one (1) death occurred at the facility. The death that occurred at the facility, was listed in the Death Certificate as ‘conditions contributing to death: myocardial infarction’. Residents interviewed stated that they receive their medications from the med techs as prescribed and have not reported any errors. Staff interviewed, stated that when medications arrive the medications are reviewed right away, and documented on the LIC 622. On 04/09/2024, LPA Urena conducted an audit of five randomly selected medications and all medications were found to be correctly recorded in the Centrally Stored Medication and Destruction Record (LIC 622) and administered as prescribed. On 06/19/2024, LPA Urena conducted staff interviews about the allegation that residents have died due to medication error. One staff stated that, “I don't recall anything about a death due to medication error; I don't recall anyone who passed away, the last time I was at this facility, was back in 2019, it has been a long time since I was there”. Another staff stated that they don’t recall the incident since they have moved throughout the different Glen Park facilities “I am all over the place”. A third staff stated that they seemed to recall an incident about a death due to medication error but did not remember the name or date of the incident.



Based on the information obtained through record review and interviews; the allegation of a questionable death, is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20230508154924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 09/04/2024
NARRATIVE
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Pg. 3
Staff is abusing residents in care.
On the allegation of that staff are abusing residents, it is the reporting’s party concern that residents are being sexually abused and bullied by Staff #1 (S1). To investigate the allegation, LPA Urena conducted residents’ interviews on 04/09/2024. The interviews revealed that the residents did not feel abused in any manner. Sometimes staff may not be friendly, but overall, they are not abusive, nor did residents feel bullied by staff. On 06/19/2024, LPA Urena conducted staff interviews. Staff interviews revealed that they don't recall anyone accusing them of abusing residents or staff either physically or sexually. Staff #1 (S1) “No one has accused me of sexual harassment, not residents or employees”. Other staff stated that they had not experienced any sexual abuse either from other staff or residents.

Based on the information received through interviews, residents and staff denied that they were abused or bullied by staff. Therefore, the allegation is deemed Unsubstantiated at this time.


Staff hide residents’ prohibited health conditions.
It is alleged that staff are hiding prohibited health conditions, and skin tears larger than a stage 4. No additional information was provided by the reporting party about the resident(s) who exhibited prohibited health conditions, or how to the reporting party acquired the information. No contact information was provided for the reporting party to obtain additional information about this allegation. To investigate the allegation, the LPA conducted residents’ interviews on 04/09/2024. The interviews revealed that none of the residents have had prohibited health conditions, nor did they have knowledge of any other resident having such conditions. On 06/19/2024, LPA Urena interviewed staff who were working at the facility at the time the allegation was made. The staff interviewed stated that they were not aware of any residents residing at the facility with prohibited conditions; furthermore, staff stated that any resident who develops a wound or prohibited condition while at the facility are sent to the hospital right away for assessment and care. Any wound care was done by a wound specialist, and we would do a one-to-one meeting to ensure the resident was being assisted. The current facility’s LVN stated that they monitor the assessment of residents’ conditions and any health-related issue they may have.
Based on the information received through interviews; the allegation that staff hide residents’ prohibited health conditions, is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20230508154924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 09/04/2024
NARRATIVE
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Pg 4.
Staff steal residents’ money.
On the allegation that staff steal residents’ money, it is the reporting party’s concern that the facility’s accounting department staff is stealing money from North Los Angeles Regional County Center (NLACRC) program and Assisted Living Waiver (ALW) program. No additional information was provided about the residents’ identifiers. No contact information was provided for the reporting party to obtain additional information about this allegation. The LPA interviewed residents on 04/09/2024 about their funds through the programs listed in the allegation. The residents stated that they work with their case workers/care coordinators and create plans to assist them in qualifying for the programs and do not receive the funds directly. The programs pay the facility. The LPA reviewed the Departments’ data system for complaints related to the allegation that may have been submitted by either the NLACRC or the ALW programs; the data searched was done for the time period between 06/01/2022 to 12/01/2023. The LPA did not find any complaints related to the allegation of the accounting department staff stealing residents’ money.

Based on the information obtained though data search done on complaints related to staff stealing residents’ money, the searched revealed that there were no complaints regarding the NLACRC or the ALW programs. Therefore, the allegation that the staff steal residents’ money, is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20230508154924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 09/04/2024
NARRATIVE
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Pg.5
Staff steal resident belongings.
On the allegation that staff steals residents’ belongings, it is alleged by the reporting party that the medical technicians (med techs) are stealing residents’ medications. No additional information was provided about the residents’ identifiers. No contact information was provided for the reporting party to obtain additional information about this allegation. To investigate the allegation the LPA interviewed residents about receiving their medication according to their daily doses and if any medications were missing. The residents interviewed stated that they receive their medications from the med techs as prescribed, one resident stated that they take only daily supplements such as vitamins, which they keep in their rooms. LPA Urena conducted an audit of five randomly selected medications and all medications were found to be correctly recorded in the Centrally Stored Medication and Destruction Record (LIC 622). On 06/19/2024, LPA Urena conducted staff interviews. The current facility’s Licensed Vocational Nurse (LVN) stated that they monitor the delivery of medications to the facility: “I review the doctor's orders, I audit the meds (go over the medications)', because different med-techs may receive them, (depending on the time of the delivery from the pharmacy) and cross check with the Centrally Stored and Destruction Record. The meds come in cycles thought out the month.” A former med-tech staff stated: “I have not been involved with medication distribution since 03/15/2022; and no, I have never done anything improper with medications. I never saw staff doing anything improper with the medications, either”. Management staff indicated that they never observed improper handling of medications.
Based on interviews, a medication audit and record review, and interviews, the LPA could not find evidence of residents’ medications being stolen. Therefore, the allegation, is deemed Unsubstantiated at this time.

Staff threaten residents in care.


The reporting party’s concern is that staff threaten residents with bodily harm and financial abuse if they complain to reporting agencies. No additional information was provided about the residents’ identifiers. No contact information was provided for the reporting party to obtain additional information about this allegation. To investigate the allegation the LPA conducted residents’ interviews. The residents interviewed stated that they have not been threaten by staff. Some residents stated that they know how to submit complaints to Licensing Department or to the Ombudsman Office and would so if necessary. On 06/19/2024, LPA Urena conducted staff interviews. The staff interviewed denied any type of abuse towards residents in care or towards staff.
Based on the information obtained through residents’ interviews, the residents have not been threatened with bodily harm, or financial abuse. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20230508154924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165
VISIT DATE: 09/04/2024
NARRATIVE
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Pg. 6
Staff are unlawfully evicting residents.
On the allegation of unlawful eviction of residents, it is the concern of the reporting party that residents are wrongfully being evicted. No additional information was provided about the residents’ eviction identifiers. To investigate the allegation, LPA Urena collected documents pertinent to the allegation. The LPA reviewed eviction notices issued from January 2023 through June 2023. The LPA identified two (2) residents that received eviction notices for non-payment of rental fees. One resident received four eviction notices dated from 08/2022 through 03/2023, a second resident received one eviction notice. Eviction Notices followed regulations and the facility's protocol based on non-payment of rental fees. The eviction notices had attached Past Due notices which totaled the amount owe for the rent, along with the Admission Agreement page that states that rental fees are due each month, and the grievance procedures a resident may follow to file a complaint. On 06/19/2024, LPA Urena interviewed staff. Staff stated that the residents who were evicted was due to non-payment of the monthly rent, “There was a non-compliant resident who called licensing several times. They were being evicted for not paying the monthly rent”.

Based on the information obtained through record review and staff interviews, two out of two evictions were done based on the admission agreement, house rules and through a formal letter. Therefore, the allegation, is deemed Unsubstantiated at this time.


No citations were issued. Exit interview was conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6